Results of a survey of antifungal susceptibility tests in the United States and interlaboratory comparison of broth dilution testing of flucytosine and amphotericin B

In a survey of 350 laboratories, 41 of 210 respondents indicated that they performed antifungal susceptibility tests. Two-thirds performed 20 or fewer tests per year, and most used a broth dilution method to test amphotericin B and flucytosine activity against Candida albicans. The broth dilution procedure of S. Shadomy and A. Espinel-Ingroff (p. 647-653, in E.H. Lennette, ed., Manual of Clinical Microbiology, 3rd ed., 1980) was the method most frequently cited, and therefore this method was used to test the susceptibility of five isolates of C. albicans and one of Saccharomyces cerevisiae to amphotericin B and flucytosine in seven research laboratories. Agreement among replicates performed on the same day by each laboratory was excellent for both drugs, all values being within 1 twofold drug dilution. Precision from week to week for each laboratory was also good, with 95 and 92% of values being within 1 drug dilution for amphotericin B and flucytosine, respectively. Interlaboratory precision, however, was poor. For amphotericin B, values varied 8- to 32-fold, and for flucytosine, they varied 32- to greater than 512-fold. We conclude that antifungal susceptibility testing is currently being performed in small volumes by numerous laboratories in the United States and that results from one laboratory may not agree with results from another. Improved standardization of fungal susceptibility tests is necessary before their results can be generally applied to clinical situations.